Normal Dimensions Research Articles

Cranial Base Changes After Trans-sutural Distraction Osteogenesis in Growing Patients With Cleft Lip/Palate and Midface Hypoplasia

Background: Transesutural distraction osteogenesis (TSDO) is a method of correcting midfacial hypoplasia (MH) secondary to cleft lip and palate (CLP) without osteotomy. However, there has been little research on how the morphology of the cranial base changes postoperatively or whether any correction of the cranial base occurs. Materials and Methods: This retrospective study included 35 pediatric patients with MH secondary to CLP, who underwent TSDO treatment. Pre-treatment and post-treatment cranial computed tomography (CT) images were collected for cranial base measurements using 3-dimensional (3D) modeling reconstruction. For the comparative analysis, 102 children with normal craniofacial CT images were selected after matching for age and sex. Results: Comparison with normal children of the same age showed that the lengths and angles of several cranial base segments approached normal levels after treatment. In total, the authors found extreme extension in the anterior segment of the sphenoid bone, and in the middle cranial fossa. Simultaneously, TSDO therapy led to the anteroposterior diameter of the lateral pterygoid processes and vomer bone greatly exceeding the normal range, thus causing forward development of the midface skeleton. Conclusion: After the TSDO procedure, the cranial base length and angles approached normal dimensions, accompanied by the forward advancement of the midfacial skeleton. Among the cranial base structures, TSDO resulted in the most noticeable increase in the sphenoid bone in terms of linear measurements and angles, thus promoting midfacial development in children.

Radiological assessment of Sella Turcica morphology correlates with skeletal classes in an Austrian population: an observational study.

This study aimed to analyze variations in the sella turcica (ST) concerning its size, shape, and bridging, providing first reference values in Austrian individuals. Additionally, it assessed associations between these morphological and demographic parameters and their correlation with patients' skeletal class. 208 lateral cephalometric radiographs (154 female, 54 male; age 8-58 years) from DPU Dental Clinic (Austria) were included. Size, skeletal class, shape, age, and gender of ST were tested for significance in correlation using, (M)ANOVA, and chi-square. Linear dimensions of ST ranged from 11.1 to 12.9mm across readers, with a standard deviation of 2.0-2.2mm. Normal ST (49.76%) and round ST (58.77%) were the most frequent. ST bridging was detected in 6.97%. Skeletal class I appeared most frequently (54.8%). Statistical significance was observed between age, gender, and ST length, with further significant age effects on ST shape. Moreover, age showed significant modification of ST shape, while skeletal parameters appeared unaffected by other ST parameters. These preliminary findings define normal ST dimensions in an Austrian population, offering reference values for clinical interpretation and broadening the available European data. Clear associations between morphological and demographic parameters were detected. Additionally, these findings may contribute to diagnostic and therapeutic strategies in orthodontics and craniofacial pathology. Future studies employing cone beam computed tomography (CBCT) along a larger sample size could enhance the generalizability of these findings.

Abstract 4123926: Suprasomatic Serial Growth of Right Heart Structures in Fetuses with Hypoplastic Left Heart Syndrome Demonstrated by Fetal Echocardiography

Background: In hypoplastic left heart syndrome (HLHS), the single right ventricle (RV) accounts for the entire cardiac stroke volume. This physiology may produce elevated transpulmonary flow velocities and dilation of the right heart structures. Little data exists regarding normal right heart dimensions and transpulmonary velocities in relation to somatic growth in these fetuses. We sought to assess serial changes in the size of right heart structures and pulmonary valve (PV) velocities in fetuses with HLHS and compare findings to fetuses with normal cardiac anatomy. Methods: A retrospective cohort study of fetuses with HLHS or normal cardiac anatomy confirmed by fetal echocardiogram between 1/1/13 – 12/31/22 was performed, excluding multiple gestation pregnancies. Fetal echocardiograms were assessed by an independent reviewer who obtained RV, PV and tricuspid valve annulus dimensions, and PV flow velocities. Nomograms were created for both HLHS and normal cohorts. The association between gestational age and PV velocity, PV annulus, RV diameter and tricuspid valve annulus was assessed and compared between groups using linear mixed models. Results: There were 290 total fetal echocardiograms for 177 patients with HLHS compared against 408 normal fetuses. [MG1] PV velocities were higher for patients with HLHS compared to normal cardiac anatomy throughout gestation (p < 0.001). In addition, the PV velocity increased more rapidly with gestational age for the HLHS (+0.02 m/s/week) group compared to those with normal cardiac anatomy (+0.01 m/s/week) (p=0.019) (Figure 1). Similarly, the RV dimension grew more rapidly with gestational age for those with HLHS (+3.2% cm/week) compared to those with normal cardiac anatomy (+2.5% cm/week) (p<0.001) (Figure 2). Lastly, the tricuspid valve annulus grew more rapidly with gestational age for patients with HLHS (+2.6% cm/week) compared to those with normal cardiac anatomy (+2.3% cm/week) (p=0.010) (Figure 3). While the PV annulus size increased with gestational age, there was not a significant difference in growth between the two groups (p=0.119). Conclusions: In fetuses with HLHS, the PV velocity, RV size and tricuspid valve size increase at a rate greater than normal somatic growth. These nomograms help identify expected RV size, tricuspid valve size and PV velocities for fetuses with HLHS and any who may deviate from the norm.

Aortic dimensions in a large Australian adult cohort. New normal range?

Abstract Background There is little published data worldwide about the normal range of aortic dimensions in adults. Guidelines for dilated aortic dimensions and recommendations for surgery are based on small population cohorts and absolute values. Adjustment for BSA and height are becoming more accepted, however the normal range of aortic dimensions for a large population has not been previously published. We present the distribution of aortic dimensions in a large Australian population, with indexation for BSA and height as well as centiles of age. Methods All patients >18 years of age attending for routine echocardiography at our institution from 2007-2022 were included in the database. Measurements of aortic root, sinotubular junction and ascending aorta using ASE criteria were collated. Dimensions were adjusted for BSA and height. Data was analysed for centiles of weight and height and across decades of age. Results A total of 117,912 patients were included in the analysis, aged 62.8+17.6 years (range 18-107), 59% male, 83.7+21.1 kgs (range 32-337) and 169.8+10.3 cm (range 107-218). The aortic root and ascending aortic dimensions are presented in absolute values (average + SD), and height adjusted (cm/m) and BSA adjusted (cm/m2) values. Data was expressed per centile of height, age and weight. There was a progressive increase in aortic dimensions as expected for increasing height, however a robust relationship was identified when dimensions were indexed according to height at all centiles regardless of age and body weight. In contrast, when adjusted for BSA, the aortic dimensions were progressively and predictably under-reported in patients over 80kg for assessment for normal vs dilated. When analysed for centiles of age, there was a small progressive increase in dimensions observed with increasing age. The indexation for height was independently robust across patients of all centiles of height. Conclusion Aortic dimensions are consistently 2.0+0.5 cm/m when adjusted for patient height across all body weight and age centiles. Adjustment for BSA in patients over 80kg tends to under-represent aortic dimensions when assessing for dilatation. Dimensions tend to increase gently with increasing age. We propose a new nomogram for normal aortic dimensions in adults.

The aortic paradox: a nationwide analysis of 523,994 individual echocardiograms exploring aortic dissection

Abstract Background Increasing aortic dilation increases risk of aortic dissection. Nevertheless, dissection occurs below guideline-directed cut-offs for prophylactic surgery. There is no current large-scale population imaging data assessing aortic dimensions before dissection. Purpose To examine the proportion of aortic dissections occurring in people with aortic diameters below guidelines for prophylactic intervention. Methods Patients within the National Echo Database of Australia (NEDA) were stratified according to absolute, height-indexed and body surface area (BSA)-indexed aortic dimensions. Fatal thoracic aortic dissections (ICD-10-AM code I79) were identified via linkage with the National Death Index. Results 524,994 individuals were assessed, comprising patients with normal aortic dimensions (n=460,992), mild dilation (n=53,402), moderate dilation (n=10,029) and severe dilation (n=572). 274,992 (52.4%) were male, with median age 64 years and median follow-up time 6.9 years. 899 fatal aortic dissections occurred (normal diameter=610, mildly-dilated aorta=215, moderately-dilated =53 and severely-dilated=21). Using normal aortas as the reference population, odds of fatal dissection increased with aortic diameter (mild=OR 3.05, 95% confidence interval (CI) 2.61-3.56; moderate=OR 4.0, 95% CI 3.02-5.30; severe=OR 28.72, 95% CI 18.44-44.72). Due to the much larger number of patients without severe aortic dilation, 97.7% of fatal aortic dissections occurred in non-severely dilated aortas. Following sensitivity analysis, severe aortic dilation was responsible for at most 24.4% of fatal aortic dissections. Results were robust for absolute, height-indexed or BSA-indexed aortic measurements. Conclusion Although severe aortic dilatation is associated with a thirty-fold increase in fatal dissection, severely dilated aortas are implicated in only 2.3-24.4% of fatal dissections. This highlights the ‘aortic paradox’ and limitations of current guidelines. Future studies should seek to refine risk predictors in patients without severe aortic dilation.

Gross morphological and ultrasonographic dimensions of normal feline kidney with reference to resistive index

Ultrasonography with color Doppler is the most quantitative analysis method for intra-renal parameters. There is a wide variation between authors in the measurement site and referencing the inter-lobar resistivity index (RI) in felines. Our objective is to morphometrically and ultrasonographically investigate the normal renal dimensions and vasculatures and draw up a normal reference value for the renal inter-lobar artery resistivity index (RI) using a Pulsed wave-Doppler ultrasonography. A total of twelve adult domestic cats were sedated and treated according to IACUC regulation guidelines to be examined using Doppler ultrasound. The same cats were used for morphometric investigation and divided into three groups regarding the used technique. The size difference between the right and left kidneys is slight, measuring 17 g (weight), 3.65 ± 0.06 cm (length), 2.54 ± 0.08 cm (width), and 2.21 ± 0.03 cm (thickness) for the right kidney, and about 15 g, 3.42 ± 0.06 cm, 2.32 ± 0.05 cm, and 2.13 ± 0.03 cm for the left one, respectively. There are three patterns of renal arteries’ point of origin. The mean RI values of both kidneys were 0.57 ± 0.08 (0.50–0.67) in the right kidney and 0.60 ± 0.08 (0.51–0.69) in the left kidney. The gross examination and ultrasonography measurements did not have a statistically different effect on the actual renal dimensions. Moreover, 0.69 is considered the standard resistivity index (RI) threshold of the feline inter-lobar artery with no correlation to the animal’s body weight.

Aortic arch anatomical differences in male type B aortic dissection patients vs. healthy male individuals

BackgroundUnderstanding the distinct anatomical differences between patients with type B aortic dissection (TBAD) and control patients (CPs) can enhance our knowledge of normal and pathological aortic dimensions. This study aimed to deepen our knowledge of these dimensions by measuring and comparing the anatomical indices of the aortic arch in male patients with TBAD and non-TBAD male patients.MethodsIn this cross-sectional observational study, 62 TBAD patients (TBADPs) and 43 CPs were assessed. Using a fit centerline approach, we identified three pivotal anatomical landmarks: Point A, Point B, and Point C. These landmarks represented intersections of the aortic arch with the brachiocephalic trunk, left common carotid artery, and left subclavian artery, respectively. These points defined Zones 1, 2, and 3, which collectively span the entire proximal aorta from the proximal end of the aortic valve to Point C. Our analyses compared key anatomical indices such as diameter of the circumscribed circle (Dcirc), ellipticity, curvature, tortuosity between TBADP and CP at critical points and regions.ResultsTBADPs showed a more circular cross-sectional shape at Points A, B and C, as indicated by reduced values of Dcirc_A (P = 0.031), ellipticity_A (P = 0.034) and ellipticity_B (P = 0.048), together with a significant decrease in Dcirc_C (P = 0.015) and ellipticity_C (P = 0.007). The aortic arch in TBADPs showed enhanced tortuosity in Zone 1 (p = 0.002) and extended elongation in Zone 3 (p = 0.001).ConclusionsThe study found that the aortic arch in male TBAD patients is more circular near its primary branches, has greater tortuosity in Zone 1, and is longer in Zone 3 compared to male control patients.

Comparative analysis of micrometric parameters in the ovaries of adolescent, elderly and senile women

Aging is a systemic process affecting all tissues of the body. In this study, the choice of scientific interest fell on the paired gland, the key structure of the female reproductive system – the ovary.Objective: to carry out a comparative analysis of the parameters of the thickness of the cerebral and cortical layers, as well as the protein membrane of the ovaries in women in adolescence, the elderly and senile age. Materials and methods. The analysis of the results of a study of 60 women with normal pelvic dimensions and without pathology of the reproductive system organs was carried out. Group I included 28 victims of adolescent age (16-20 years old), group II consisted of 29 elderly victims (56-74 years old), group III included 27 elderly victims (75-90 years old). The thickness of the cerebral and cortical layers, as well as the albumen of both ovaries, were determined in histological samples.Results. A decrease in the thickness of the cortical and medulla and an increase in the thickness parameters of the albuminous membrane of both ovaries in the period from adolescence to old age were revealed. The thickness of the medulla of the right ovary is thinned by 3.76%, the left by 4.46%; the cortical substance of the right ovary by 29.9%, the left by 29.64% (p < 0,01). The thickness of the albumen of the right ovary, on the contrary, increases by 48.23%, of the left – by 50.21% (p < 0,01). From old age to senile age, there is a tendency to decrease the thickness of the cerebral and cortical matter of the ovary. The medulla is thinned by 0.95% on the right and 0.24% on the left (p > 0,05), the cortical substance – by 1.5% on the right and 1.21% on the left (p > 0,05). At the same time, the protein shell on the right becomes thicker by 14.08%, on the left – by 13.57% (p < 0,01). Conclusion. The results obtained can become a conditional "morphological standard" for certain age norms in the diagnosis of various diseases, as well as expand the understanding of changes in the morphological picture of a woman's ovaries with age.

Establishment of Z score reference of liver, spleen, and kidney parameters for Egyptian children and adolescents: a cross-sectional randomized study

BackgroundAmong various growth parameters, liver and spleen size is an important parameter used for the evaluation of patients with certain disorders and abnormalities in these organs.AimTo determine the normal dimensions for the liver, spleen, and kidney in Egyptian infants, children, and adolescents from birth to 18 years.MethodsThis cross-sectional randomized study was conducted on 1861 Egyptian infants, children, and adolescents from birth to 18 years for the establishment of Z score reference of liver, spleen, and kidney parameters.ResultsEgyptian children of both sexes (51.5% boys and 48.5% girls) from birth to 18 years old were studied. Then Z scores reference for liver, spleen, and kidney parameters for both sexes were represented in detailed tables and graphs. There was no statistically significant difference between both sexes, so we used unisex tables and graphs (P > 0.05).ConclusionsDetermination of pathologic changes in the size of the liver, spleen, and kidney necessitates knowing the normal range of dimensions for these organs. So, our study established a Z score chart for normal values of liver, spleen, and kidney size for children and adolescents from birth to 18 years.

Ultrasonographic parameters of the liver, spleen and kidney in a healthy paediatric population in Bosnia and Herzegovina: a prospective study.

To determine the normative range of ultrasound dimensions for the liver, spleen and kidneys in healthy children according to gender, age, body measurements, body surface area (BSA), and the influence of ethnicity on organ size. The prospective study included children, ranging from full-term neonates to children aged 15, with normal ultrasonographic (US) findings of the liver, spleen and kidney and no clinical evidence of a disease. Gender, age, as well as body measurements and BSA, were determined for each child along with US measurements, and normative ranges were established. US images of the liver and spleen from 372 children and 366 US images of kidneys of 366 children were included. US measurements of the liver, spleen and kidney correlated well with gender, age, body weight and height, and often differed to a greater or lesser extent from the normal range of measurements (5th to 95th percentile) reported in other studies. Our results differed slightly from other reports conducted in Europe, but larger differences compared to measurements performed on children on other continents were found. Thus, our study confirmed that ethnically appropriate and modern tables of normal ultrasound dimensions for the liver, spleen and kidneys should be used, and that the national nomogram is justified.

Kidney Dimensions and its Correlation with Anthropometric Parameters in Healthy North Indian Adults

Background: Knowledge of kidney size is important in the assessment of kidney function. Changes in kidney size can occur in various kidney diseases due to different causes, hence knowledge of normal kidney dimensions in a population is crucial for diagnosis, follow-up and prognostication. While data from other parts of the world does not apply to the Indian population due to differences in ethnicity, diet and body sizes, and there is also a lack of standardized data on normal kidney sizes in healthy Indian adults. Materials and Methods: Kidney dimensions from 600 healthy adult volunteers ranging between 20 and 70 years of age were measured with sonography by a single radiologist. Differences in dimensions between men and women, and right and left kidney were analyzed. Finally, kidney sizes were correlated with anthropometric variables such as weight, age, body surface area (BSA), height and body mass index. Estimated glomerular filtration rate (eGFR) was correlated with kidney length and renal parenchymal volume (RPV). Results: The mean kidney length of the whole cohort, irrespective of gender was found to be 9.6 ± 0.7 cm on the right and 9.9 ± 0.7 cm on the left. Mean kidney length in males was significantly more as compared to females on both sides. Both the kidney length and RPV were significantly associated with BSA, weight and height (in that order) in females, whereas in males, kidney length and RPV best correlated with height, BSA and weight (in that order). In both sexes, there was a significant negative correlation between age and kidney length, RPV. eGFR had a significant positive correlation with kidney length and RPV in the cohort. Conclusion: Normal sonographic mean kidney length was 9.6±0.7 cm and 9.9±0.7 cm on the right and left sides respectively in healthy North Indian population, with the left kidney being larger than the right in all dimensions (length, width, thickness and RPV). Kidney sizes in males were found to be larger than females. Correlation with anthropometric parameters in our study, emphasizes the need to give due consideration to normal variations in kidney sizes with age, gender, height, weight and BSA to differentiate between a normal and a pathologically small or large kidney.

Sonographic Measurement and Sex Variability of Portal Vein in a Sample of Sudanese Adults

<i>Background: </i>Measurements of the normal portal venous dimension in a species population is so crucial. portal vein can be measured by several methods for assessing different parameters, Computed topography (CT) and sonographic imaging are common examples. The diagnosis of portal hypertension depends on the transverse portal vein diameter (normal diameter from 6-15 mm). The aim of this study is to assess the portal vein diameter and correlate the diameter with age, sex, weight, height and BMI in Sudanese populations. <i>Methodology: </i>This was a descriptive cross-sectional study that included a sample of Sudanese adults who were requested to have routine abdominal sonographic scanning due to reasons not related to liver or portal vein problems. The study was carried out at the Radiology Department of Qatar Alnada Hospital, Umbadda, Khartoum, Sudan 2022. <i>Results:</i> In this study, 376 participants were included of which more than half were females (56.1%, n=211), while 165 (43.9%) were males. The mean age of the participants was 38.12 + 15.57 years. The mean portal vein diameter was 10.79 + 1.27 millimeters. From this study the portal vein diameter varied with age (p value = 0.000), weight (p value = 0.002), height (p value = 0.000) and sex (p value = 0.000). It is not related to BMI (p value = 0.3). <i>Conclusion: </i>This study revealed that the portal vein diameter has positive correlation with age, sex, height, and weight of the person and has no correlation with the BMI.

A Comprehensive Overview of the Ulianov Theory

BThis article provides a comprehensive overview of the Ulianov Theory (UT), a pioneering model formulated by Dr. Policarpo Yoshin Ulianov. The UT offers a revolutionary approach to understanding the universe, anchored in mathematical rigor and logical scrutiny. Central to its framework is a redefined conception of time, positing it as a digital and complex variable time dimension and aligning the notion of imaginary time, with six digital spatial dimensions (three normal space dimensions an three spatial wrapped dimensions) named as General Octo-Dimension Universe (GODU), that also can see like four five-dimensions subuniverses separate by walls of space and walls of time, an original idea proposed by Issac Asimov in 1966 to explain a ”four leaf clover universe” beginning for noting, with the antimatter universes going to the negative time direction (travel to the past before the Big Bang). The Ulianov theory present a 12 basic particles model (6 particles and 6 antiparticles, like the quarks) seems as elastic holes in walls of time and space. The connections between it proposes particles properties (mass and electric charge) are familiar within our observable universe. In challenging prevailing scientific paradigms, UT beckons the scientific community to reassess foundational beliefs. The UT is based on only two fundamental forces (gravitational and eletromagnetic), replacing the Nuclear Strong add Week Forces by an Gravitational Contact Force, that becomes in play only wen two masses becomes in contact (with a Planck distance between then). Additionally, the article delves into a novel String Theory model (when photons, protons electrons and neutrons are basically the same length string, but wrapped in distinct ways). The UT also presents the ”Small Bang” hypothesis, suggesting the universe’s genesis from a small and cold space bubble (only a Planck length of diameter), with antimatter micro black hole becomes supermassive antimatter black holes and generating matter and antimatter (in the same proportion), stolen energy by the cosmic inflation field. Within the UT’s purview, seminal equations from classical physics, Einstein’s theories of relativity, and quantum mechanics are eloquently derived.

Normal cardiac dimensions by magnetic resonance imaging and topographic anatomy of the adult arabian one-humped camel (Camelus dromedarius)

BackgroundDromedaries’ normal heart architecture and size have not been adequately examined utilizing magnetic resonance imaging (MRI) and topographic anatomy.Resultwe aimed to investigate the regular appearance of the heart and its dimensions, using MRI and cross-sectional anatomy, in mature Arabian one-humped camels (Camelus dromedarius). We also analyzed hematological and cardiac biochemical markers. MRI scans were conducted on twelve camel heart cadavers using a closed 1.5-Tesla magnet with fast spin echo (FSE) weighted sequences. Subsequently, the hearts were cross-sectionally sliced. Additionally, hematobiochemical studies were conducted on ten mature live camels. The study analyzed standard cardiac dimensions including HL, BW, RA, LA, RV, LV, IVS, LAD, RAD, RVD, AoD, TCVD, and MVD. The results showed a strong positive correlation between the cardiac dimensions obtained from both gross analysis and MR images, with no significant difference between them. On both gross and MRI images, the usual structures of the heart were identified and labeled. Along with the cardiac markers (creatine kinase and troponin), the average hematological values and standard biochemical parameters were also described.ConclusionAccording to what we know, this investigation demonstrates, for the first time the typical heart structures and dimensions of the heart in dromedaries, and it could serve as a basis for diagnosing cardiac disorders in these animals.

Cardiomyocyte Notch1 signaling is essential for protection of the maternal heart from peripartum stress

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft Background Peripartum cardiomyopathy (PPCM) is a life-threatening disease in women without known cardiovascular disease and is characterized by a sudden onset of heart failure (HF) before, under or after delivery. Previous studies suggest impaired endothelial to cardiomyocyte crosstalk as a major pathomechanism of the disease. Purpose Analyses of the role of Notch1 signaling for the endothelial-cardiomyocyte crosstalk in PPCM. Methods and results Serum from PPCM patients with acute HF reduced Notch1 expression in induced pluripotent stem cell derived cardiomyocytes (-20%, P<0.05) compared to serum from postpartum-matched healthy controls (PP-Ctrl). Beside miRNA-146a previously described to be up-regulated in PPCM plasma (6.8-fold, P<0.01), additional miRNAs targeting Notch1 signaling (miR-30a-3p, miR-34a, miR-200b-3p, miR-200c-3p, miR-429-3p, miR-449a) were up-regulated in PPCM plasma. Overexpression of these miRNAs in cardiomyocytes (CM) reduces Notch1 protein levels. Mice with a CM-restricted knockout of Notch1 (N1-KO) are born at the expected Mendelian ratio and nulli pari (NP) N1-KO female mice do not show a distinct cardiac phenotype at the age of 3 to 4 months compared to WT female mice (%FS WT: 41±5 vs N1-KO: 37±6; n= 9-12). However, they develop mild HF at the age of 6 months (%FS WT: 44±4 vs N1-KO: 31±8; n=11-14; P<0.01). Mated N1-KO females displayed normal cardiac function and LV dimensions in the last week of the first pregnancy. After 3 pregnancies and nursing periods, N1-KO developed severe HF (%FS WT PP: 30±5 vs N1-KO PP: 16±5; n=8-12; P<0.01), and show enhanced mortality (P<0.01). N1-KO-NP and N1-KO-PP displayed significant increase in the cardiac expression of the stress markers ANP and BNP compared to respective WT-NP and WT-PP. RNA-Seq analysis of N1-KO-PP revealed 1380 transcripts (adj. P<0.01) differently regulated genes, among them down-regulation of ErbB4, a known driver in PPCM onset. SiRNA-mediated knockdown of Notch1 in CM were associated with a decrease in ErbB4 protein expression. Treatment with bromocriptin (BR) was not able to improve survival and to rescue cardiac function and LV dimensions in postpartum N1-KO females (WT: 37±4, N1-KO: 23±10; n=7-8). Moreover, RNA-Seq analysis revealed that BR had no effect on the dysregulated cardiac mRNA. In conclusion, the pathophysiology of PPCM is associated with reduced cardiac Notch1 expression, which results in part from 16-kDa-prolactin mediated upregulation of miRNAs targeting Notch1. The reduced cardiac Notch1 expression contributes to PPCM as indicated with severe postpartum HF and high mortality in N1-KO mice. Inhibition of prolactin secretion with BR failed to rescue the development of PPCM in N1-KO mice suggesting that deregulated Notch1 is downstream of the 16-kDa prolactin-miRNA pathophysiology.

The aortic paradox: a nationwide analysis of 523 994 individual echocardiograms exploring fatal aortic dissection.

Increasing aortic dilation increases the risk of aortic dissection. Nevertheless, dissection occurs at dimensions below guideline-directed cut-offs for prophylactic surgery. Currently, there are no large-scale population imaging data assessing aortic dimensions before dissection. Patients within the National Echo Database of Australia were stratified according to absolute, height-indexed, and body surface area (BSA)-indexed aortic dimensions. Fatal thoracic aortic dissections (ICD-10-AM Code I71) were identified via linkage with the National Death Index. A total of 524 994 individuals were assessed, comprising patients with normal aortic dimensions (n = 460 992), mild dilation (n = 53 402), moderate dilation (n = 10 029), and severe dilation (n = 572). A total of 274 992 (52.4%) were males, with a median age of 64 years and a median follow-up time of 6.9 years. Eight hundred and ninety-nine fatal aortic dissections occurred (normal diameter = 610, mildly dilated aorta = 215, moderately dilated = 53, and severely dilated = 21). Using normal aortas as the reference population, odds of fatal dissection increased with aortic diameter [mild = odds ratio (OR) 3.05, 95% confidence interval (CI) 2.61-3.56; moderate = OR 4.0, 95% CI 3.02-5.30; severe = OR 28.72, 95% CI 18.44-44.72]. Due to the much larger number of patients without severe aortic dilation, 97.7% of fatal aortic dissections occurred in non-severely dilated aortas. Following sensitivity analysis, severe aortic dilation was responsible for at most 24.4% of fatal aortic dissections. The results were robust for absolute, height-indexed, or BSA-indexed aortic measurements. Although severe aortic dilatation is associated with a near-30-fold increase in fatal dissections, severely dilated aortas are implicated in only 2.3-24.4% of fatal dissections. This highlights the 'aortic paradox' and limitations of current guidelines. Future studies should seek to refine risk predictors in patients without severe aortic dilation.

Targeting serotonin receptor 7 to improve survival after myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft (DFG) Background Myocardial infarction (MI) is among the leading causes of death worldwide. Survival and long-term recovery are highly dependent on regeneration of the cardiac tissue, mediated by precisely regulated inflammatory processes and invading immune cells. The serotonergic system is known to regulate the functions of various cells of the immune system, and is also affected in several cardiovascular diseases. Purpose We investigated the role of the serotonin receptor 7 (5-HT7R) in regulation of the inflammatory response after MI and its contribution to cardiac outcome. Methods Permanent left ascending coronary artery ligation (LAD) in mice was used as a model for MI. We compared the impact of MI on heart function and tissue integrity in WT and 5-HT7R-KO mice. In addition, we performed a systemic treatment with the selective 5-HT7R agonist LP-211. Results Murine C57BL/6N hearts reveal an upregulation of 5-HT7R mRNA expression in the infarct region compared to remote myocardium and sham operated mice at 3, 7 and 14 days after MI. Immunohistochemistry demonstrates 5-HT7R expression mainly on CD68+, CD206+ and CD80+ macrophages but not on cardiomyocytes and fibroblasts. Systemic 5-HT7R-KO mice display normal cardiac function and dimensions at 3-4 months of age comparable to their wildtype (WT) littermates. In response to MI, 5-HT7R-KO mice show a higher decrease in left ventricular (LV) function (assessed by transthoracic echocardiography as fractional area change, FAC%) and increased signs of tissue inflammation 14 days post-MI, while the infarct size remains unchanged. Interestingly, systemic treatment with the selective 5-HT7R agonist LP-211 enhances survival rates 14d post MI, without improving cardiac functional output. Conclusion 5-HT7R expression is upregulated post-MI in heart-invading inflammatory cells, such as macrophages. Loss of systemic 5-HT7R may contribute to pronounced functional cardiac impairment 14 days after MI, while systemic activation of 5-HT7R shows positive effects on survival, possibly through mediated inflammatory signalling of immune cells. Therefore, 5-HT7R activity could represent a novel therapeutic target to dampen inflammation and improve cardiac repair.

A "PARADOXICAL" MINOCA

Abstract Background The acronym MINOCA refers to myocardial infarction with normal or near–normal coronary arteries on invasive angiography. We report a case of MINOCA caused by paradoxical coronary embolism due to a right–to–left shunting through a patent fossa ovalis. Integrated multimodality imaging diagnostic work–up has been crucial for identifying the mechanism underlying MINOCA. Case Report A 48–year–old male was admitted to the Coronary Care Unit for sudden–onset oppressive chest pain lasting 1 hour, radiating to the left arm; no specific changes in ST–segment on a 12–lead ECG and elevated high–sensitive troponin I (peak value 1562 ng). Transthoracic echocardiography showed normal dimensions and function of the cardiac chambers and excluded valvular and pericardial diseases. Given the characteristics of the chest pain, we performed an urgent coronary angiography that showed normal epicardial coronary, including testing for epicardial coronary spasm and microvascular dysfunction. We also used Optical Coherence Tomography on LAD e RCA to rule out critical stenosis and sign of plaque instability. To investigate the etiology of myocardial damage the patient underwent a cardiac magnetic resonance (CMR) imaging that yielded the following findings: hypokinesis of the inferior–middle segment of the left ventricle associated myocardial edema and near transmural LGE. These features were consistent with a recent ischemic injury. Additionally, CMR showed an atrial septal aneurysm and a channel–like pattern of the interatrial septum, raising the suspicion of patent foramen ovale (PFO). The transesophageal echocardiography and transcranial Doppler with bubble test confirmed the presence of a PFO responsible for right–to–left shunting. Atrial fibrillation was excluded with ECG telemetry throughout the entire 7day hospitalization. Conclusions Based on the result of the overall clinical–instrumental evaluation, MINOCA caused by paradoxical coronary embolism due to a right–to–left shunting through a PFO was considered the most plausible diagnostic hypothesis. The patient underwent to interventional percutaneous closure of PFO and was discharged with no symptoms or complication at the follow–up.

PROSTHETIC GRAFT INFECTION: WHEN ECHOCARDIOGRAPHY IS NOT ENOUGH!

Abstract A 68–year–old Caucasian male, post–Bentall procedure with a bioprosthetic valve following extensive aortic dissection involving the ascending aorta and aortic arch, presented to the Emergency Department with persistent fever for over a month. During his hospitalization, he experienced ventricular fibrillation in the setting of hypokalemia, successfully managed with Advanced Cardiovascular Life Support (ACLS) and DC shock, leading to the restoration of sinus rhythm. Subsequently, he was admitted to the Cardiovascular Intensive Care Unite. Blood tests revealed neutrophilic leukocytosis with elevated inflammatory markers, anemia, and a troponin curve consistent with myocardial injury in the context of sepsis and anemia. Echocardiography demonstrated a left ventricle of normal dimensions with globally depressed function (EF 45%), attributed to apical akinesia. The prosthetic valve was functioning normally, and there were no signs of endocarditic vegetations or pericardial involvement. A transesophageal echocardiogram confirmed the absence of vegetations. Given echocardiographic signs of myocardial ischemia, coronary angiography was performed, revealing a coronary circulation free from significant stenosis. Cultural exams showed positivity for Enterococcus faecalis. A PET–CT revealed the presence of radioisotope uptake around the vascular prosthesis situated in the aortic arch. An Infectious Disease specialist recommended antibiotic therapy with Piperacillin/Tazobactam and Teicoplanin. At the one–month follow–up, the patient remained asymptomatic, free from new febrile episodes. The follow–up echocardiogram indicated improved global systolic function, and inflammatory markers remained consistently negative. Repeat blood cultures were negative. This case illustrates a suspected endocarditis on a prosthetic valve where both transthoraci and transesophageal echocardiography yielded negative results. The use of PET–CT, on the other hand, revealed the presence of vascular graft infection, proving to be a valuable method in this clinical setting.

MISDIAGNOSED PARTIAL ANOMALOUS PULMONARY VENOUS RETURN AS A CAUSE OF RIGHT VENTRICULAR DILATION IN TRICUSPID VALVE DYSPLASIA

Abstract A 38–year–old woman comes to our attention for regular follow–up of a known tricuspid valve dysplasia, diagnosed since she was 19 years old. The patient has been persistently asymptomatic and hemodynamically compensated. In previous cardiac assessments, there was moderate and stable tricuspid regurgitation (TR) that never reached the diagnostic criteria for Ebstein‘s anomaly (7 mm). The right atrium was dilated, and the right ventricle was at the upper limits of normal dimensions. However, our evaluation revealed a worsening of TR to a severe degree, associated with valvular annulus dilation and severe dilation of the right ventricle, which remained normokinetic, and evident diastolic overload of the interventricular septum. Therefore, a cardiac surgery intervention was indicated to correct the valvulopathy. During hospitalization, a transthoracic echocardiogram was repeated to investigate a possible cause of right ventricular overload, not fully explained by the relatively short duration of severe TR. During the exam, suspecting Partial Anomalous Pulmonary Venous Return (PAPVR) as one of the possible determinants, a vessel compatible with left superior pulmonary venous return was visualized, which converged into the anonymous vein and then into the right superior vena cava. Further diagnostic investigation with magnetic resonance angiography and computed tomography angiography confirmed the severe dilation of the right cardiac chambers and the presence of left upper pulmonary venous return and part of the left lower lobe into the left anonymous vein, with a Qp/Qs of 1.7 in relation to the pre–tricuspidal shunt. Therefore, a cardiac surgery intervention was indicated for PAPVR correction. However, previously unnoticed thrombocytosis was revealed in the hematological exams, leading to the initiation of a pertinent hematological workup and the cardiac surgery intervention was postponed to reduce the risk of perioperative complications. In conclusion, PAPVR is a rare congenital condition that can remain asymptomatic until adulthood due to a chronic adaptation of the right heart to volume overload and should, therefore, be considered in the differential diagnosis of right cardiac chambers dilation, especially when other causes do not justify its pathophysiology.